Childhood memories of threatening experiences and submissiveness and its relationship to hallucination proneness and ideas of reference: The mediating role of dissociation

Recent studies have emphasized the importance of childhood memories of threatening experiences and submissiveness in a diversity of psychological disorders. The purpose of this work was to study their specific relationship with hallucination proneness and ideas of reference in healthy subjects. The ELES scale for measuring memory of adverse childhood experiences, the DES ‐II scale for measuring dissociation, the LSHS ‐R scale for measuring hallucination proneness, and the REF for ideas of reference were applied to a sample of 472 subjects. A positive association was found between childhood memories of adverse experiences and hallucination proneness and ideas of reference, on one hand, and dissociation on the other. A mediation analysis showed that dissociation was a mediator between the memory of adverse childhood experiences and hallucination proneness on one hand, and ideas of reference on the other. When the role of mediator of the types of dissociative experiences was studied, it was found that absorption and depersonalization mediated between adverse experiences and hallucination proneness. However, this mediating effect was not found between adverse experiences and ideas of reference. The relationship between these last two variables was direct. The results suggest that childhood memories of adverse experiences are a relevant factor in understanding hallucination proneness and ideas of reference. Similarly, dissociation is a specific mediator between adverse childhood experiences and hallucination proneness.     

A development of Freudian metapsychology for schizophrenia

The author states that psychoanalysis has much to contribute to schizophrenia. Beginning with a development of Freudian metapsychology, he addresses the in‐depth psychopathological study of a session (the first on the couch) with a schizophrenic patient who hears voices and feels that he is being watched. Since the symptoms appear at the level of the heard word and the visual image – key to Freudian metapsychology – he delineates a circuit for the word and one for the image, describing a blockage in both and the consequences of these. Furthermore, with regard to the patient's progress, he demonstrates first a quantitative improvement in symptoms, and later qualitative changes in his functioning. He shows how, over a time, functioning is improved in a once‐a‐week on‐the‐couch setting after two years of face‐to‐face treatment.     

“Seeing Rain”: Integrating phenomenological and Bayesian predictive coding approaches to visual hallucinations and self-disturbances (Ichstörungen) in schizophrenia

We present a schizophrenia patient who reports “seeing rain” with attendant somatosensory features which separate him from his surroundings. Because visual/multimodal hallucinations are understudied in schizophrenia, we examine a case history to determine the role of these hallucinations in self-disturbances (Ichstörungen). Developed by the early Heidelberg School, self-disturbances comprise two components: 1. The self experiences its own automatic processing as alien to self in a split-off, “doubled-I.” 2. In “I-paralysis,” the disruption to automatic processing is now outside the self in omnipotent agents. Self-disturbances (as indicated by visual/multimodal hallucinations) involve impairment in the ability to predict moment-to-moment experiences in the ongoing perception-action cycle. The phenomenological approach to subjective experience of self-disturbances complements efforts to model psychosis using the computational framework of hierarchical predictive coding. We conclude that self-disturbances play an adaptive, compensatory role following the uncoupling of perception and action, and possibly, other low-level perceptual anomalies.     

The borderlands of waking: Quantifying the transition from reflective thought to hallucination in sleep onset

We lose waking consciousness spontaneously and regularly over the circadian cycle. It seems that every time we fall asleep, reflective thinking gradually gives way to our interactions with an imaginary, hallucinatory world that brings multimodal experiences in the absence of adequate external stimuli. The present study investigates this transition, proposing a new measure of hallucinatory states. Reflective thinking and motor imagery were quantified in 150 mentation reports provided by 16 participants after forced awakenings from different physiology-monitored time intervals after sleep onset. Cognitive agency analysis and motor agency analysis – which are objective (grammatical–semantic) tools derived from linguistic theories – show (i) a decrease in reflective thinking which sleepers would need to acknowledge the hallucinatory quality of their state, and (ii) an increase in motor imagery, indicating interactions with a hallucinatory world. By mapping these spontaneous changes in human consciousness onto physiology, we can in the long run explore the conditions of its decline, and possibilities for treatment.     

Negative hallucinations,dreams and hallucinations: The framing structure and its representation in the analytic setting

This paper explores the meaning of a patient's hallucinatory experiences in the course of a five times a week analysis. I will locate my understanding within the context of André Green's ideas on the role of the framing structure and the negative hallucination in the structuring of the mind. The understanding of the transference and countertransference was crucial in the creation of meaning and enabling the transformations that took place in the analytic process. Through a detailed analysis of a clinical example the author examines Bion's distinction between hysterical hallucinations and psychotic hallucinations and formulates her own hypothesis about the distinctions between the two. The paper suggests that whilst psychotic hallucinations express a conflict between life and death, in the hysterical hallucination it is between love and hate. The paper also contains some reflections on the dramatic nature of the analytic encounter.     

Alien voices and inner dialogue: towards a developmental account of auditory verbal hallucinations

The phenomenon of auditory verbal hallucinations (AVHs) is one of the most intriguing features of the psychiatric literature. Two alternative models of the development of AVHs in both normal and psychotic populations are proposed. In the disruption to internalisation (DI) model, AVHs result from a disruption to the normal processes of internalisation of inner speech. In the re-expansion (RE) model, AVHs result when normal inner speech is re-expanded into inner dialogue under conditions of stress and cognitive challenge. Both models draw on Vygotsky's (The Collected Works Of L.S. Vygotsky, New York, Plenum Press, 1987) ideas about the development of inner speech. On this view, normal inner speech is considerably abbreviated relative to external speech, and also undergoes some important semantic transformations. In both the DI and RE models, AVHs arise when the subject's inner speech involves inappropriately expanded inner dialogue, leading the subject to experience the voices in the dialogue as alien. The two models may prove useful in explaining some of the social-developmental evidence surrounding the phenomenon, and also make a number of testable predictions which are suggested as priorities for future research.     

Flicker-light induced visual phenomena: frequency dependence and specificity of whole percepts and percept features

Flickering light induces visual hallucinations in human observers. Despite a long history of the phenomenon, little is known about the dependence of flicker-induced subjective impressions on the flicker frequency. We investigate this question using Ganzfeld stimulation and an experimental paradigm combining a continuous frequency scan (1–50 Hz) with a focus on re-occurring, whole percepts. On the single-subject level, we find a high degree of frequency stability of percepts. To generalize across subjects, we apply two rating systems, (1) a set of complex percept classes derived from subjects’ reports and (2) an enumeration of elementary percept features, and determine distributions of occurrences over flicker frequency. We observe a stronger frequency specificity for complex percept classes than elementary percept features. Comparing the similarity relations among percept categories to those among frequency profiles, we observe that though percepts are preferentially induced by particular frequencies, the frequency does not unambiguously determine the experienced percept.     

The roles of thought suppression and metacognitive beliefs in proneness to auditory verbal hallucinations in a non-clinical sample

In a non-clinical sample (N = 751), we investigated relations among two subscales (self-reported intrusiveness of unwanted thoughts and thought suppression) of the White Bear Suppression Inventory (WBSI), metacognitive beliefs, and proneness to auditory verbal hallucinations (AVHs). Both subscales of the WBSI were found to be related to AVH-proneness and strongly positively related to metacognitive beliefs about the uncontrollability and danger of thoughts. Regression analyses were used to test models of the relations among AVH-proneness and a range of metacognitive beliefs. When the WBSI subscale relating to the self-reported intrusiveness of unwanted thoughts was controlled for, the metacognitive style that was the strongest predictor of AVH-proneness was cognitive self-consciousness. Cognitive confidence and beliefs about the uncontrollability of thoughts were also significant predictors of AVH-proneness. These findings are used to revise existing models of the relations between metacognitive beliefs and AVHs. Implications for the management of AVHs are discussed.     

The psychological processes underlying symptoms of thought interference in psychosis

Morrison and colleagues have proposed that auditory hallucinations are the result of cognitive intrusions being misattributed to an external source due to such thoughts being inconsistent with the person's beliefs about his or her own mental processes (metacognitive beliefs). The aim of this study was to investigate the applicability of this model to psychotic symptoms of thought interference. Fifty psychotic patients with and without thought interference were compared on (i) frequency of cognitive intrusions, (ii) metacognitive beliefs, (iii) source monitoring and (iv) appraisals of an unrelated anomalous event (a card trick). As predicted, individuals with thought interference had an increased frequency of cognitive intrusions and of maladaptive metacognitive appraisals, lower perceived cognitive control, and were more likely to endorse appraisals regarding 'permeability' of the mind, on the card trick task, in comparison to individuals without thought interference. No significant differences were found on any measure when the patient group was divided into hallucinators and non-hallucinators, once other variables were controlled for. These findings suggest that Morrison's model may be more parsimonious for symptoms of thought interference than for auditory hallucinations.